骶骨肿瘤术前供血动脉栓塞的临床应用  

Clinical application of blood supply artery embolization of sacral tumor before surgical resection

作　　者：刘玉金[1] 徐家华[2] 武清[2] LIU Yujin, XU Jiahua, WU Qing.(Department of Interventional Radiology, Affiliated Yueyang Hospital of Integrated Traditional Chinese ＆ Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, Chin)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院介入科,200437 [2]上海中医药大学附属龙华医院介入科

出　　处：《介入放射学杂志》2018年第5期464-467,共4页Journal of Interventional Radiology

摘　　要：目的评估骶骨肿瘤供血动脉的来源及术前栓塞的价值。方法对42例骶骨肿瘤手术切除前24 h内以明胶海绵颗粒对供血动脉进行栓塞。肿瘤包括脊索瘤14例、神经鞘瘤8例、转移瘤7例、骨软骨肉瘤3例、骨肉瘤1例、骨巨细胞瘤5例、成血管细胞瘤1例、多发性骨髓瘤1例、血管肉瘤1例、成软骨细胞瘤1例。结果根据骶骨肿瘤的位置及大小不同,供血动脉来源不一致。42例造影提示肿瘤供血动脉有98支,其中右腰2动脉1支、左腰3动脉1支、右腰3动脉3支、左腰4动脉6支、右腰4动脉8支、左腰5动脉1支、左骶外侧动脉9支、右骶外侧动脉11支、左髂腰动脉1支、右髂腰动脉6支、骶正中动脉1支、左臀上动脉10支、右臀上动脉8支、左臀下动脉10支、右臀下动脉8支、左阴部内动脉8支、右阴部内动脉6支。肿瘤染色均较术前减少75%以上,栓塞24 h内行肿瘤切除术,术中、术后24 h内出血量40~7 200 m L,平均(1 255.2±982.1)m L。所有肿瘤均顺利切除,无严重并发症。结论骶骨肿瘤血供来源复杂,术前充分栓塞供血动脉能有效减少术中出血,降低手术危险性,提高肿瘤手术切除率。Objective To investigate the origins of tumor-feeding arteries of sacral tumors and to assess the clinical value of preoperative embolization of sacral tumor before surgical resection. Methods Percutaneous transcatheter embolization of tumor-feeding arteries with gelfoam particles was performed in 42 patients with sacral tumor 24 hours before its surgical resection. The lesions included chordoma（n =14）,neurilemmoma（n=8）, metastatic tumor（n=7）, chondrosarcoma（n=3）, osteosarcoma（n=1）, giant cell tumor of bone（n=5）, hemangioblastoma（n=1）, multiple myeloma（n=1）, angiosarcoma（n=1） and chondroblastoma（n=1）. Results Depending on tumor＇s location and size, the origins of tumor-feeding artery of sacral tumors were different from one to another. Angiography of the 42 patients showed that a total of 98 tumor-feeding arteries were detected, including right second lumbar artery（n=1）, left third lumbar artery（n=1）, right third lumbar artery（n=3）, left fourth lumbar artery（n=6）, right fourth lumbar artery（n=8）, left fifth lumbar artery（n=1）, left lateral sacral artery（n=9）, right lateral sacral artery（n=11）, left ilio-lumbar artery（n=1）, right ilio-lumbar artery（n=6）, median sacral artery（n=1）, left superior gluteal artery（n=10）, right superior gluteal artery（n =8）, left inferior gluteal artery（n =10）, right inferior gluteal artery（n =8）, left internal pudendal artery（n =8）, and right internal pudendal artery（n =6）. After embolization therapy, the tumor staining markedly decreased by more than 75% when compared with the pre-embolization angiographic manifestations. Surgical resection of sacral tumor was carried out within 24 hours after embolization. The amount of blood loss in operation and within 24 hours after surgery was（40-7 200） m L, with a mean of（1 255.2±982.1） m L. The tumor was successfully removed in all patients, and no serious complications occurred.Conclusion The origin of blood supply for sacral

关 键 词：骶骨肿瘤 新辅助化疗 供血动脉 

分 类 号：R681.5[医药卫生—骨科学]